In keeping with the media’s broader and long-running effort to destigmatize obesity, NPR reported sympathetically in December that some doctors are refusing to talk about the health risks of obesity with their overweight patients, claiming that attending to the obesity of these patients leads to “misdiagnoses.”
The story begins with an account of a Seattle woman who complains that when she needed surgery for a torn ligament in her thumb, the surgeon gave her “unsolicited advice” to lose weight. The surgeon reasoned, she said, that her obesity could be a causal factor in her injury, which the patient even admitted “could be true.” (And medical evidence supports the surgeon’s perspective.)
But rather than accept the potentially useful insights of the surgeon, the Seattle woman was outraged that her obesity would be made an object of medical interest.
Best practice in the business of primary-care doctoring involves plenty of what NPR and the woke doctors they interviewed for the piece call “unsolicited advice.” Much of the useful medical advice doctors give is “unsolicited.” Patients typically do not know the epidemiology of their symptoms, and they are also typically uninformed about how to recognize problematic health issues before symptoms begin.
If Bob is diagnosed with skin cancer after spending many summers shirtless and hatless with no sunblock, his doctor does well to give him the “unsolicited advice” to start either wearing shirts and hats more often or to introduce himself to sunscreen. If the doctor does not do this, he is not doing his job. And in choosing to communicate that information to Bob, the doctor should not consider whether Bob might feel bad for a minute if he assumes the doctor is making a judgment about his attention to skin care.
The Seattle woman in the story claims it’s “freaking exhausting” to deal with doctors informing her that her obesity might be negatively affecting her health. And the NPR writer dutifully reports the baseline of medical knowledge on this issue: “For years, weight has been used as a measure of health in doctors’ offices. Having a higher body mass index is correlated with heart disease, diabetes, certain types of cancer and other conditions.”
The author then goes on immediately to reject that knowledge, with a claim about the negative effects of attending to obesity: “But in recent years, research has shown that when clinicians focus on weight, it can lead patients to avoid or delay health care, including recommended cancer screenings.”
That is to say, the fact that some obese patients are so sensitive about their weight that they will avoid going to the doctor at all if they suspect he might do his job by communicating accurate medical knowledge about the effects of obesity is reason enough for doctors to stop presenting those unwelcome truths to patients.
The article claims that doctors often regularly misdiagnose health problems in the obese because they are too focused on obesity, but it provides no convincing evidence of this claim. Such evidence would have to be substantial, given the fact that obesity is clearly correlated to so many health disparities, and so there will be very substantial health costs involved in discontinuing our present medical attention to obesity. One interviewed doctor claims, “There’s so many horrible stories … of diagnoses that were missed because the focus was on weight,” but the article gives no examples.
The solution, NPR claims, is perhaps “weight-neutral” care, or a focus on “health at every size.” This means, in the language of one of the doctors interviewed, “We don’t recommend weight loss as a way of treating medical conditions.”
This is simply an abandonment of one of the principal things doctors are supposed to do, which is to provide information to patients about how to stay healthy. The doctor who says the above goes on to tell the reporter that even if an obese patient indicates a desire to lose weight, she informs the patient that “it is likely to fail in the long term.”
This is technically true, as most obese people who attempt to lose weight fail to maintain the healthy eating and exercise regimes needed to succeed long-term. But in moral terms, this is a cripplingly negative thing for a doctor to communicate to a patient. It wold be like a physician encouraging a patient to keep puffing cigarettes just because long-term smoking causes an elevated risk of lung cancer for years even after discontinuing the habit. Most success in becoming healthier is qualified and complicated, but that doesn’t mean doctors should throw in the towel.
NPR tries to justify this doctor’s medical malpractice by noting that “a meta-analysis of 29 long-term weight loss studies found that, on average for people with obesity, more than half of the weight lost was regained within two years and that more than 80% was regained within five years.”
But this is to assume that the patient before you is “average.” We indeed know that, on average, many people who try to lose weight fail. We also know that “on average” people with a mesothelioma diagnosis die very quickly. But someone forgot to tell Stephen Jay Gould about this, and he wrote a famous article showing why it’s a grievous mistake for someone with that diagnosis to assume imminent death without further careful consideration of the uniqueness of his position. It is frankly amazing to see physicians advocating just the kind of statistically ignorant logic that Gould skewers.
The NPR article concludes: “People with larger bodies still need to feel heard and respected in the doctor’s office and have their primary health concerns addressed.”
If there were one phrase I could disappear from the English language, it would be “my need to feel heard.” Say something reasonable, and people will typically be happy to hear you. But say foolishness, and you can expect to be ignored — whether because the listener doesn’t wish to embarrass you or because you’re just a fool.
